What we need to worry about are the postmodern killers: jobs with a deadly combination of high demand and low control, jobs that require high effort and dole out low rewards. As Adler's MacArthur Foundation report, "Reaching for a Healthier Life", puts it: "Jobs that are plagued by time pressure, conflicting demands, low control over how and when tasks get done, worker/management conflict, threats of pay cuts or job loss, and conflicts between family obligations and work requirements can create damaging levels of stress that surface in disease."

The biggest proof of that came from the first Whitehall study, which found that the greater incidence of heart disease at the bottom of the bureaucratic pecking order was due mainly to a lack of job control - that is, limited permission to solve problems and make decisions. Other diseases associated with low job control cited by both Whitehall studies are type 2 diabetes and alcohol dependence. That's no surprise; men who have a hard time coping with stress tend to turn to alcohol.

But perhaps the most stunning finding from Whitehall II came from 6000 civil servants who were asked to agree or disagree with this statement: "I often have the feeling that I am being treated unfairly." Those who agreed moderately or strongly were clustered on the lower rungs of the British civil service system. And by following this group for 11 years, researchers learnt that those who felt the most shabbily treated were

55 per cent more likely to have had a heart attack in the interim.

Several other small studies in various countries have confirmed these findings to some extent, says Dr Mark Cullen, a professor of medicine at Yale University. But he thinks the real issue isn't low control; it's psychological stress. "It's the burden that matters," he says. "How much they want from you, how fast they want it, how perfect it has to be." And in his opinion, the amount of stress you feel from your job has a lot to do with whether the job fits you - that is, whether it matches your personality and style and the other demands in your life.

Some people actually like low-control jobs. After all, they just want to punch in and punch out. But if you come home at the end of the day feeling angry, alienated and exhausted, maybe you need more than a new job; you need a new line of work. "The biggest problems," says Cullen, "are with a misfit." If you're a misfit, fix it - or you'll die trying.

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